Bleeding to death, in a hospital, under the care of nurses and physicians is not what any family should consider a risk of twin delivery. But this is what happened to a family at their local birth hospital.
Mom was only 36 years old when she became pregnant a second time; her first delivery was a normal spontaneous vaginal delivery of a singleton girl. Her second pregnancy a few years later, were twin girls.
She started her prenatal care early with a board certified obstetrician. She had regular pre-natal visits without any problem being identified. Since this pregnancy was twins she was referred to a specialist-a maternal fetal medicine physician-for periodic sonograms. All were normal.
She arrived at her birth hospital early in the morning on the day of delivery. She was at term and in labor. Maternal and fetal assessment done on arrival were normal. The plan was to perform a Cesarean section (C-Section) due to both her slightly advanced age (36) and the presence of twins.
All of her care and the plan for delivery were appropriate and well within the standard of care. The problem was the hospital she was in and the date-the weekend of July 4th. Holiday weekends are dangerous because experienced staff can be on holiday leave and under staffing is common.
Problems after a successful C-Section delivery were immediately apparent. After the twins and the placenta were delivery, the uterus continued to bleed. This is not uncommon in twins or any multiple gestation. The uterus is larger than in a singleton, and often its muscle tone is diminished. The term often used to characterize the tone is "boggy".
Uterine bleeding after the required removal of the placenta is common but normally the uterus "clamps down" on the bleeding vessels and shuts them off. Medication can also be given to increase the tone of the uterus. This was done. However, it was inadequate to stop the uterine bleeding; some of the blood continued to come out through the vagina and additional blood collected in the uterus.
Due to the holiday, adequate blood replacement products (red blood cells and platelets) were not immediately available.
This bleeding became so severe, that her vital signs deteriorated. Blood pressure dropped and heart rate increased; the technical terms are hypotension and tachycardia. This bleeding had to be stopped as soon as possible. Since conservative measures were not working and adequate blood products were not immediately available, a hysterectomy was the only life-saving option. However, a C-Section requires an anesthesiologist. The one who did the anesthesia for the C-Section left for another hospital without an immediate back up being present and without telling the obstetrician.
The hysterectomy was finally performed some 4 hours after the bleeding problem was first noticed. The patient by that time was in hemorrhagic shock. The bleeding was stopped. The patient died of blood loss.
The hospital made no offer to settle. The jury verdict was unanimous 12-0 against the hospital.
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